Kroeze, N.L. (2023) Mortality after coronary artery bypass grafting versus percutaneous coronary intervention for patients with left main stem stenosis: a retrospective cohort study. thesis, Medicine.
Full text available on request.Abstract
Background: The most appropriate treatment for left main coronary artery disease (LMCAD) remains controversial after the most recent European guidelines have been dismissed. This study aimed to compare mortality between the most relevant treatment options: percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for patients with LMCAD. Methods: This study was a retrospective cohort study, set in Medical Spectrum Twente (MST) in the Netherlands from 2018 till 2020. Patients were eligible if they were diagnosed with LMCAD, discussed in the heart team, and received PCI or CABG. Endpoints of this study were mortality and re-intervention for PCI vs CABG, mortality for PCI vs CABG per SYNTAX-score group, and mortality for PCI received due to rejection of CABG vs PCI received and eligible for CABG. Kaplan-Meier curves were computed for the comparisons and Cox regression was used to estimate Hazard risks and correct for confounding. Results: 236 patients were included, of which 147 patients received PCI and 89 patients received CABG. Kaplan-Meier estimates of mortality in the first year of follow-up, were 8.8% in the PCI group and 8.9% in the CABG group (p=0.84). The estimates from one year until 58 months of follow-up, were 24.8% in the PCI group and 5.3% in the CABG group (p=0.02). The Kaplan-Meier estimate corrected for confounding showed no significant difference (p=0.11). The estimates for re-intervention after 1 year were not significantly increased for either group (6.4% in PCI group, 2.3% in CABG group, p=0.19 and p=0.29 corrected for confounding). The analysis of the mortality between patients rejected from CABG vs patients not rejected from CABG proved significant, with event rates of 75% in the PCI group and 22% in the CABG group (p=0.01). Last, the analysis on mortality per SYNTAX-score group showed a higher cumulative event rate for the PCI in all groups, however, this was not significant. Conclusions: This study showed that surgery should remain the standard treatment option for patients with LMCAD with a long life-expectancy. PCI remains a viable option for patients with a short life expectancy and patients not eligible for surgery. This study can be used for patient education or to draw hypothesis for further research regarding treatment options for LMCAD.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Halfwerk, Dr. F.R. and Speekenbrink, Dr. R.G.H and Stoel, Dr. M.G. |
| Faculty: | Medical Sciences |
| Date Deposited: | 24 Apr 2023 12:59 |
| Last Modified: | 24 Apr 2023 12:59 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3490 |
Actions (login required)
 |
View Item |